RESUMO
BACKGROUND: Parkinson's disease is incurable, idiopathic, degenerative, and progressive, and affects about 1% of the elderly population. Multidisciplinary clinical treatment is the best and most adopted therapeutic option, while surgical treatment is used in less than 15% of those affected. In practice, there is a lack of reliable and validated scales for measuring motor impairment, and monitoring and screening for surgical indications. OBJECTIVE: To develop and validate an instrument for measuring parkinsonian motor impairment in candidates for neurosurgical treatment. METHOD: The development and validation methods followed published guidelines. The first part was the choice of domains that would make up the construct: cardinal signs of disease (tremor, rigidity (stiffness), posture/balance/gait, hypokinesia/akinesia, and speech), along with pain and dyskinesia. A multi-professional working group prepared an initial pilot instrument. Ten renowned specialists evaluated, judged, and suggested modifications to the instrument. The second phase was the evaluation of the content of each domain and the respective ability to classify commitment intensity. The third phase was the correction of the main flaws detected and new submission to the board. The instrument was applied to 41 candidates for neurosurgical treatment in two situations: with and without medication RESULTS: The final form received 100% agreement from the judges. Its average time for application was 8 min. It was very responsive (p = 0.001, Wilcoxon) in different situations (On-Off). CONCLUSION: TRASP-D is a valid instrument for measuring motor impairment in patients with Parkinson's disease who are candidates for neurosurgical treatment. It allows measurement in multiple domains with reliability and sensitivity.
Assuntos
Transtornos Motores , Doença de Parkinson , Idoso , Humanos , Hipocinesia/diagnóstico , Hipocinesia/etiologia , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Doença de Parkinson/tratamento farmacológico , Reprodutibilidade dos Testes , TremorRESUMO
BACKGROUND AND OBJECTIVES: Chronic pain affects between 30% and 50% of the world population. Our objective was to estimate the prevalence of chronic pain in Brazil, describe and compare differences between pain types and characteristics, and identify the types of therapies adopted and the impact of pain on daily life. METHODS: Cross-sectional study of a population-based survey with randomized sample from a private database. The interviews were conducted by phone. 78% of the respondents aged 18 years or more agreed to be interviewed, for a total of 723 respondents distributed throughout the country. Independent variables were demographic data, pain and treatment characteristics, and impact of pain on daily life. Comparative and associative statistical analyses were conducted to select variables for nonhierarchical logistic regression. RESULTS: Chronic pain prevalence was 39% and mean age was 41 years with predominance of females (56%). We found higher prevalence of chronic pain in the Southern and Southeastern regions. Pain treatment was not specific to gender. Dissatisfaction with chronic pain management was reported by 49% of participants. CONCLUSION: 39% of interviewed participants reported chronic pain, with prevalence of females. Gender-associated differences were found in intensity perception and interference of pain on daily life activities.
Assuntos
Atividades Cotidianas/psicologia , Dor Crônica , Percepção/fisiologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Planejamento em Saúde Comunitária , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência , Distribuição Aleatória , Distribuição por Sexo , Inquéritos e Questionários , Adulto JovemRESUMO
Cognitive impairment can negatively impact daily routine. This fact encouraged the elaboration of this study, which analyzed the impact of pain treatment with opioids on attention. Patients were divided into groups that were given (n=14) and were not given opioids (n=12). Three interviews were conducted to assess attention using the Trail Making Test and the Digit Span Test. The groups were homogeneous regarding socio-demographic variables, pain and depression; they were not homogeneous regarding the Karnofsky scale and the use of adjuvant analgesics. The patients in treatment without opioids had better performance in the Digit Span Test-reverse order, in the second assessment (p = 0.29); no differences were observed on the Trail Making Test. The observed impairments were limited, but while new studies do not confirm the findings, patients, professionals and caregivers must be alert about the possible deleterious effects of opioids on the cognitive function.